CIGNA Dental Plan Documents - John Carroll University

• your divorce or legal separation; or
• for a Dependent child, failure to continue to qualify as a
Dependent under the Plan.
Who is Entitled to COBRA Continuation
Only a “qualified beneficiary” (as defined by federal law) may
elect to continue health insurance coverage. A qualified
beneficiary may include the following individuals who were
covered by the Plan on the day the qualifying event occurred:
you, your spouse, and your Dependent children. Each
qualified beneficiary has their own right to elect or decline
COBRA continuation coverage even if you decline or are not
eligible for COBRA continuation.
The following individuals are not qualified beneficiaries for
purposes of COBRA continuation: domestic partners, same
sex spouses, grandchildren (unless adopted by you),
stepchildren (unless adopted by you). Although these
individuals do not have an independent right to elect COBRA
continuation coverage, if you elect COBRA continuation
coverage for yourself, you may also cover your Dependents
even if they are not considered qualified beneficiaries under
COBRA. However, such individuals’ coverage will terminate
when your COBRA continuation coverage terminates. The
sections titled “Secondary Qualifying Events” and “Medicare
Extension For Your Dependents” are not applicable to these
individuals.
FDRL85
Secondary Qualifying Events
If, as a result of your termination of employment or reduction
in work hours, your Dependent(s) have elected COBRA
continuation coverage and one or more Dependents experience
another COBRA qualifying event, the affected Dependent(s)
may elect to extend their COBRA continuation coverage for
an additional 18 months (7 months if the secondary event
occurs within the disability extension period) for a maximum
of 36 months from the initial qualifying event. The second
qualifying event must occur before the end of the initial 18
months of COBRA continuation coverage or within the
disability extension period discussed below. Under no
circumstances will COBRA continuation coverage be
available for more than 36 months from the initial qualifying
event. Secondary qualifying events are: your death; your
divorce or legal separation; or, for a Dependent child, failure
to continue to qualify as a Dependent under the Plan.
Disability Extension
If, after electing COBRA continuation coverage due to your
termination of employment or reduction in work hours, you or
one of your Dependents is determined by the Social Security
Administration (SSA) to be totally disabled under title II or
XVI of the SSA, you and all of your Dependents who have
elected COBRA continuation coverage may extend such
continuation for an additional 11 months, for a maximum of
29 months from the initial qualifying event.
To qualify for the disability extension, all of the following
requirements must be satisfied:
1. SSA must determine that the disability occurred prior to or
within 60 days after the disabled individual elected COBRA
continuation coverage; and
2. A copy of the written SSA determination must be provided
to the Plan Administrator within 60 calendar days after the
date the SSA determination is made AND before the end of
the initial 18-month continuation period.
If the SSA later determines that the individual is no longer
disabled, you must notify the Plan Administrator within 30
days after the date the final determination is made by SSA.
The 11-month disability extension will terminate for all
covered persons on the first day of the month that is more than
30 days after the date the SSA makes a final determination
that the disabled individual is no longer disabled.
All causes for “Termination of COBRA Continuation” listed
below will also apply to the period of disability extension.
Medicare Extension for Your Dependents
When the qualifying event is your termination of employment
or reduction in work hours and you became enrolled in
Medicare (Part A, Part B or both) within the 18 months before
the qualifying event, COBRA continuation coverage for your
Dependents will last for up to 36 months after the date you
became enrolled in Medicare. Your COBRA continuation
coverage will last for up to 18 months from the date of your
termination of employment or reduction in work hours.
FDRL21
Termination of COBRA Continuation
COBRA continuation coverage will be terminated upon the
occurrence of any of the following:
• the end of the COBRA continuation period of 18, 29 or 36
months, as applicable;
• failure to pay the required premium within 30 calendar days
after the due date;
• cancellation of the Employer’s policy with CIGNA;
• after electing COBRA continuation coverage, a qualified
beneficiary enrolls in Medicare (Part A, Part B, or both);
• after electing COBRA continuation coverage, a qualified
beneficiary becomes covered under another group health
plan, unless the qualified beneficiary has a condition for
which the new plan limits or excludes coverage under a pre-
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